Premium
Reconstructive algorithm and classification system for transoral oropharyngeal defects
Author(s) -
Almeida John R.,
Park Richard Chan Woo,
Villanueva Nathaniel L.,
Miles Brett A.,
Teng Marita S.,
Genden Eric M.
Publication year - 2014
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.23353
Subject(s) - swallowing , medicine , transoral robotic surgery , dysphagia , surgery , reconstructive surgery , microsurgery , transoral laser microsurgery , perioperative , algorithm , radiation therapy , head and neck cancer , computer science
Background Transoral techniques for oropharyngeal tumors, such as transoral robotic surgery (TORS) and transoral laser microsurgery, require new reconstructive considerations. Methods Defects from 92 patients undergoing TORS were classified into 4 classes. A reconstruction algorithm was followed. Perioperative outcomes and complications were assessed. Forty‐seven patients completed the MD Anderson Dysphagia Inventory (MDADI) swallowing questionnaire and a modified Velopharyngeal Insufficiency Quality of Life (VPIQL) questionnaire postoperatively. Results The most common reconstructions involved velopharyngoplasties with local flaps (39%), local flaps alone (25%), or secondary healing (20%). More advanced defects (class III and IV defects) required regional and free flaps more often. No significant differences were found in MDADI scores or VPIQL scores among the 4 defect classes. Only adjuvant radiotherapy was a predictor of poor swallowing ( p = .02). Conclusion The classification system for transoral oropharyngeal defects maps defects into 4 classes and guides the reconstructive thought process. © 2014 Wiley Periodicals, Inc. Head Neck 36: 934–941, 2014